The National Institute for Health and Care Excellence (NICE) plays a crucial role in deciding which medicines are available on the NHS in England. Mounjaro, the brand name for tirzepatide, has received NICE approval for two distinct uses: managing type 2 diabetes and supporting weight loss. The eligibility criteria for accessing the drug differ based on the condition being treated.
The NICE Criteria for Mounjaro in Weight Management
NICE guidance for Mounjaro in managing overweight and obesity specifies that it must be used alongside a reduced-calorie diet and increased physical activity. Due to high demand and cost, NHS England has implemented a phased rollout, prioritizing patients with the highest clinical need.
In the initial phase, eligibility is extremely strict, and patients must meet all of the following conditions:
- BMI Threshold: A Body Mass Index (BMI) of 40 kg/m² or higher. This threshold is lower for individuals from certain ethnic backgrounds (e.g., South Asian, Chinese, Middle Eastern, Black African) who may be eligible with a BMI of 37.5 kg/m² or more due to a higher risk of obesity-related health problems at a lower BMI.
- Comorbidities: A confirmed diagnosis of at least four specific weight-related health conditions. The qualifying comorbidities include Type 2 diabetes, High blood pressure (Hypertension), Cardiovascular disease, High cholesterol or abnormal blood fats (Dyslipidaemia), and Obstructive sleep apnoea.
- Lifestyle Support: Patients must also agree to participate in a structured 'wraparound care' programme that includes nutritional guidance, physical activity support, and behavioral coaching.
- Treatment Review: After six months on the highest tolerated dose, treatment should be discontinued if less than 5% of the patient's initial body weight has been lost.
NICE Guidelines for Mounjaro and Type 2 Diabetes
For adults with insufficiently controlled type 2 diabetes, NICE recommends tirzepatide under specific conditions, typically after other treatments have proven ineffective or unsuitable. These criteria include specific requirements related to BMI, comorbidities, and previous treatments, with different thresholds for certain ethnic backgrounds. More details are available on the {Link: bmj.com https://www.bmj.com/content/382/bmj.p2074} website.
Comparison of NICE Criteria for Mounjaro vs. Wegovy
| Feature | Mounjaro (Tirzepatide) | Wegovy (Semaglutide) |
|---|---|---|
| Indication | Weight management & Type 2 Diabetes | Weight management |
| Initial BMI (Obesity) | 40+ kg/m² (lower for certain ethnic groups) with ≥4 comorbidities | 35+ kg/m² with ≥1 comorbidity; or 30-34.9 kg/m² with ≥1 comorbidity and referral criteria met |
| Prescription Setting | Initially available in primary care for highest need patients; broader rollout planned | Exclusively prescribed within specialist weight management services (hospital-based) |
| Treatment Duration | No specified time limit, ongoing as long as weight loss benefit is maintained | Maximum of 2 years |
| Mandatory Support | Requires participation in a lifestyle support program | Requires multidisciplinary management from specialist services |
The Phased Implementation of Mounjaro on the NHS
NHS England's phased rollout of Mounjaro is due to the high cost and the need for new service capacity. The timeline prioritizes patients with the most severe health risks.
- Phase 1 (June 2025–June 2026): For patients with a BMI of 40+ (or 37.5+ for ethnic minorities) who have at least four comorbidities. Prescribing through GP services.
- Phase 2 (June 2026–March 2027): Includes people with a BMI of 35–39.9 and four or more comorbidities.
- Phase 3 (April 2027 onwards): Expands to individuals with a BMI of 40+ and three or more comorbidities, subject to review and NHS capacity.
What Happens If You Don't Meet the NICE Criteria?
Because NHS-funded Mounjaro eligibility is strict, especially initially, most people won't qualify. This phased approach manages costs and ensures safe delivery.
If you don't meet the NHS criteria, your GP may offer alternatives like local weight management services or other medications if appropriate. Private prescriptions are also an option if clinical criteria are met. For more details, consult NHS England or NICE guidance.
Conclusion
The NICE criteria for Mounjaro dictate who can access this treatment on the NHS for weight management and type 2 diabetes. Access is currently limited by strict BMI and comorbidity thresholds and a phased rollout. For weight management, participation in a lifestyle support program and demonstrating a minimum weight loss are also required. Understanding these criteria is essential as NHS access expands.
